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General NPI Number Information
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NPI Number | 1275002289
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Entity Type | Individual
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Provider Name | LUIS PEREZ DMD
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Gender | Male
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 2050 40TH AVE STE 6
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City | VERO BEACH
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State | FL
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Zip | 32960-2467
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Country | US
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Telephone | 772-569-9781
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 40TH AVE STE 6
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City | VERO BEACH
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State | FL
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Zip | 32960-2467
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Country | US
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Telephone | 772-569-9781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23856
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License Number State | FL
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